Membership of the Faculty of Public Health (MFPH) Disease Prevention, Health Promotion and Screening Flashcards

24 sample cards from the Disease Prevention, Health Promotion and Screening deck

Sampled from the end of the deck, so these are different cards from the ones shown on the syllabus page.

1. What is social marketing in health promotion?

   The systematic application of commercial marketing concepts and techniques to achieve specific behavioural goals for social good. It uses customer/audience insight, the marketing mix (product, price, place, promotion), audience segmentation, exchange theory and competition analysis.

2. What does the evidence suggest about the effectiveness of mass media campaigns for health behaviour change?

   Mass media campaigns can raise awareness and shift knowledge and attitudes across large populations and can produce modest behaviour change, but are most effective when sustained, well-funded, theory-based and combined with other interventions (e.g. legislation, services); used alone they may widen inequalities.

3. Define nudge theory ('libertarian paternalism').

   Influencing behaviour predictably through changes to the 'choice architecture' without forbidding options or significantly changing economic incentives, so people can still freely choose. Popularised by Thaler and Sunstein in 'Nudge'.

4. Give examples of choice-architecture interventions ('nudges') used in public health.

   Setting healthy defaults (e.g. opt-out organ donation, default water instead of fizzy drinks); changing placement (healthy foods at eye level); portion-size reduction; salience/framing of information; and social-norm feedback. Summarised in the MINDSPACE and EAST frameworks.

5. Distinguish active from passive immunisation.

   Active immunisation stimulates the recipient's own immune system to produce a protective (often long-lasting) response, via live attenuated or inactivated vaccines/toxoids/subunits. Passive immunisation provides pre-formed antibodies (e.g. immunoglobulin, maternal transplacental IgG) giving immediate but temporary protection.

6. Distinguish live attenuated from inactivated vaccines, giving an example of each.

   Live attenuated vaccines contain weakened organisms that replicate to produce strong, often lifelong immunity but are generally contraindicated in pregnancy and immunosuppression (e.g. MMR, BCG, rotavirus, nasal flu). Inactivated/subunit vaccines contain killed organisms or components, are safer in those groups but usually need boosters (e.g. inactivated polio, hepatitis B, diphtheria/tetanus toxoid).

7. Define herd (population) immunity and the herd immunity threshold formula.

   Herd immunity is the indirect protection of susceptible individuals that occurs when a sufficiently high proportion of the population is immune, interrupting transmission. The threshold proportion is $$H_{t}=1-\frac{1}{R_{0}}$$ where $R_{0}$ is the basic reproduction number.

8. For a disease with basic reproduction number $R_{0}=12$ (e.g. measles), what proportion must be immune for herd immunity?

   $$H_{t}=1-\frac{1}{R_{0}}=1-\frac{1}{12}\approx 0.92$$ so about 92–95% must be immune, which is why very high measles vaccine coverage is required.

9. List the routine UK childhood immunisations given at 8, 12 and 16 weeks of age.

   8 weeks: 6-in-1 (DTaP/IPV/Hib/HepB), rotavirus, MenB. 12 weeks: 6-in-1 (2nd dose), pneumococcal (PCV), rotavirus (2nd dose). 16 weeks: 6-in-1 (3rd dose), MenB (2nd dose).

10. What vaccines are given at one year of age in the UK schedule?

    Around 12–13 months: Hib/MenC booster, MMR (1st dose), pneumococcal (PCV) booster, and MenB (3rd/booster dose).

11. What immunisations are offered to UK adolescents and the elderly?

    Adolescents: HPV vaccine (around year 8, age 12–13), and the teenage booster of Td/IPV plus MenACWY (around 14). Older adults: annual influenza, pneumococcal polysaccharide (PPV23) at 65, shingles vaccine, and RSV vaccine for older adults; pertussis and RSV are also offered in pregnancy.

12. What is the 6-in-1 vaccine and when is it given in the UK?

    A combined vaccine protecting against diphtheria, tetanus, pertussis (whooping cough), polio, Haemophilus influenzae type b (Hib) and hepatitis B (DTaP/IPV/Hib/HepB), given as a primary course at 8, 12 and 16 weeks of age.

13. What is the difference between a vaccine adverse event and an adverse reaction?

    An adverse event following immunisation (AEFI) is any untoward medical occurrence after vaccination that is temporally associated but not necessarily causally related. An adverse reaction is an AEFI that is judged to be causally related to the vaccine.

14. What is the Yellow Card Scheme?

    The UK's spontaneous pharmacovigilance reporting system, run by the MHRA, through which healthcare professionals and the public report suspected adverse drug reactions and adverse events following immunisation, contributing to ongoing safety monitoring.

15. What are the strengths and limitations of spontaneous (passive) pharmacovigilance reporting?

    Strengths: cheap, covers the whole population and all products, can detect rare or unexpected (signal) reactions and works from the moment of licensing. Limitations: under-reporting, reporting bias, no denominator so incidence cannot be calculated, and it cannot prove causation.

16. Define vaccine hesitancy (WHO SAGE).

    A delay in acceptance or refusal of vaccines despite availability of vaccination services. It is context-specific, varies across time, place and vaccine, and is influenced by factors captured in the '3 Cs' model: Confidence, Complacency and Convenience.

17. Explain the '3 Cs' (and extended '5 Cs') model of vaccine hesitancy.

    3 Cs: Confidence (trust in vaccine safety/effectiveness and providers), Complacency (low perceived risk of disease so vaccination seen as unnecessary), and Convenience/Constraints (accessibility, affordability, availability). The 5 Cs add Calculation (information searching/risk weighing) and Collective responsibility.

18. What interventions improve vaccine uptake?

    Reminder/recall systems, default/opt-out scheduling, improving access (extended hours, outreach, school/pharmacy delivery), reducing cost barriers, provider recommendation and training, addressing misinformation, community engagement and tailored communication, and financial/non-financial incentives. Multicomponent approaches work best.

19. What is the 'cold chain' in immunisation programmes?

    The system of transporting and storing vaccines within the recommended temperature range (typically +2°C to +8°C for most vaccines) from manufacture to administration, to preserve potency. It requires reliable refrigeration, monitoring, trained staff and a fail-safe process for handling breaches.

20. What is a cold-chain breach and how is it managed?

    An excursion of vaccine storage temperature outside the recommended +2°C to +8°C range. Management: quarantine affected vaccines (do not use or discard immediately), record the temperatures and duration, and seek advice from the manufacturer or local immunisation/medicines team on whether the stock remains usable.

21. Define vaccine efficacy and its formula.

    Vaccine efficacy is the proportional reduction in disease incidence (attack rate) in the vaccinated group compared with the unvaccinated group under trial conditions: $$VE=\frac{ARU-ARV}{ARU}=1-RR$$ where ARU and ARV are the attack rates in unvaccinated and vaccinated, and RR is the relative risk.

22. Distinguish vaccine efficacy from vaccine effectiveness.

    Efficacy is the protection measured under ideal, controlled conditions (e.g. a randomised trial). Effectiveness is the protection observed in real-world field use, which is usually lower because of factors such as cold-chain lapses, varied population health, timing and coverage.

23. What is a 'catch-up' immunisation campaign and when is it used?

    A supplementary activity to vaccinate individuals who missed routine doses or to rapidly raise population immunity (e.g. during an outbreak or after introducing a new vaccine), aiming to close immunity gaps and reach the herd-immunity threshold; it complements routine ('selective') programme delivery.

24. Why does the population strategy risk widening or narrowing health inequalities, and what is a key counter-measure?

    Population-wide interventions can widen inequalities if more advantaged groups adopt them faster ('intervention-generated inequalities'). Proportionate universalism — delivering universal action with intensity proportionate to need (Marmot) — is the key counter-measure to reduce the social gradient in health.

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